MRIs May Drive More Women to Mastectomy

May 16, 2008

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"The study is alarming, and it has always been our worst fears that breast MRI might result in increasing use of mastectomy for breast cancer," Kuerer added. "However, the key take-home message for women and their doctors is to insist that any suspicious findings on MRI be biopsied before the decision to undergo mastectomy is made."

Moreover, a study published in the January 2008 issue of the Journal of Clinical Oncology showed that use of an MRI did not improve breast cancer recurrence rates.

Traditionally, MRI was used only on women with dense breasts or those in a very high risk bracket for developing breast cancer. But today, many experts say that the use of MRI is on the rise, and is having an undeniably detrimental effect on patient outcomes without having any benefit for disease outcomes.

"I am very concerned about this," said Dr. Michael Sabel, associate professor of surgery in the Division of Surgical Oncology at the University of Michigan. "Here you have doctors ordering MRI on every breast cancer patient, leading to more mastectomies and not decreasing the local recurrences seen in the women having lumpectomy. That means MRI is detrimental."

"As it is being used right now, it is hurting more women than it is helping," Sabel said.

Mastectomy a Growing Choice

Such a trend first entered into the public eye when former first lady Nancy Reagan opted for a full mastectomy over a lumpectomy in 1987 -- a time when nearly every woman with breast cancer wanted nothing more than to conserve her breasts.

Today, more and more women seem to opt for mastectomy over breast conservation. Goetz said he believes one reason for this might be the plethora of new breast reconstruction options that women have available after losing one or both of their breasts with this surgery.

And although there is currently no data to support the idea that this trend in increased mastectomy rates is occurring nationwide, many experts said they have witnessed the increase in their own practice.

"I have definitely seen that trend in my practice," said Dr. Christina Finlayson, director of the Dianne O'Connor Thompson Breast Center at the University of Colorado Hospital.

According to Finlayson, her own experience has lead her to believe that part of the reason for the increase in mastectomy rates is because of the increased use of MRI, but patient preference also accounts for a large part of it.

"I think that 20 years or so ago, when women were given the option of breast conservation, there was a huge interest in not 'having to have a mastectomy,'" Finlayson explained. "Now I think the pendulum is shifting toward -- 'I don't ever want to have to think about this again,' and 'I want to do everything possible'."

Because mastectomy, and particularly bilateral mastectomy -- the removal of both breasts rather than one -- obviates the need for future mammography and biopsies, many more women seem to be choosing mastectomy out of the belief that it will allow them never to have to worry about another breast cancer scare again.

"The problem, however, is that the data doesn't support any improved outcomes with mastectomy over breast conservation," Finlayson said. "It is very hard, however, to alter emotion with data."

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